UNFPA Inter-Agency Reproductive Health Kits for Crisis Situations

Publication date: 2006

DRAFT Manual Inter-Agency Reproductive Health Kits for Crisis Situations 4th edition DRAFT TABLE OF CONTENTS Page 1. Introduction 1 1.1 Basics 1 1.2 General Remarks - Key points to remember 2 1.3 Obtaining the Kits 3 1.3.1. Who can order the Kits 3 1.3.2. Contact points within UNFPA 3 1.3.3. Conditions to be fulfilled for ordering Kits 3 1.3.4. Funding 4 1.3.5. Cost of the Kits 4 1.3.6. Delivery of the order 4 1.3.7. Information required by the UNFPA Procurement Unit when ordering 4 1.3.8. Kit packing 5 1.4 Practical information 6 1.5 Example of an order for a refugee camp of 20,000 persons 7 2. Composition of the Reproductive Health Kits 9 Block 1 Six kits for 10,000 persons/3 months 9 Kit 0: Administration kit 10 Kit 1: Condom kit: Part A and B 11 Kit 2: Clean Delivery kit (individual): Part A (mother) and B (birth attendant) 12 Kit 3: Rape Treatment kit 13 Kit 4: Oral and Injectable Contraception 14 Kit 5: Treatment of Sexually Transmitted Infections 15 Block 2 Five kits for 30,000 persons/3 months 16 Kit 6: Delivery kit (Health Facility) 17 Kit 7: Intra Uterine Device 20 Kit 8: Management of Miscarriage and Complications of Abortion 21 Kit 9: Suture of Tears (vaginal and cervical) and Vaginal Examination kit 23 Kit 10: Vacuum Extraction for Delivery (Manual) kit 24 Block 3 Two kits to be used at referral/surgical maternity level for 150,000 persons/3 months 25 Kit 11: Referral level kit for Reproductive Health 26 Part A: Reusable equipment 26 Part B: Drugs and disposable equipment 28 Kit 12: Blood Transfusion kit 30 Annex Complementary information 31 Cost of kits: separate leaflet 32 Order form: separate leaflet 33 DRAFT ACKNOWLEDGEMENT In 1996, the members of the Inter-Agency Working Group (IAWG) on Reproductive Health in Refugee Situations developed the concept and the original set of Emergency Reproductive Health Kits with the goal of facilitating the timely and appropriate delivery of reproductive health services in emergency and refugee situations. This is the third version of the RH Kits. Reviews of experience with the kits were first conducted in 2000 and then in 2003 and in 2005. These reviews led to modifications of the contents of the kits, based on suggestions of users and on newly identified need. This booklet provides information on use, contents, and ordering procedures for the adapted set of kits as of December 2006. Many individuals participated in the preparation of the four versions of the Reproductive Health Kits. They include: Kate Burns, Pamela Delargy, Wilma Doedens, France Donnay, Fidel Font, Lorelei Goodyear, Robin Gray, Ann Janssens, Myriam Henkens, Patricia Hindmarsh, Monir Islam, Sandra Krause, Serge Malé, Matthews Mathai, Janet Meyers, Doris Mugrditchian, Thidar Myint, Francis Ndowa, Roselidah Ondeko, Anne Petitgirard, Daniel Pierotti, Hakan Sandbladh, Christian Saunders, Michel Tailhades, Susan Toole, and Beverly Tucker. The major contribution of Annick Debruyne and Thérèse Delvaux is gratefully acknowledged. This is the fourth version of the Manual on Reproductive Health Kits. Users are invited to make comments on this revised and updated version of the RH Kit. All inputs will be considered for future revisions. December 2006 DRAFT 1. INTRODUCTION 1.1. BASICS 1 A major objective of the Program of Action adopted at the International Conference on Population and Development held in Cairo in September 1994, was to make reproductive health care- including family planning - accessible to all individuals by the year 2015. The Program of Action specifically called attention to the needs of especially vulnerable populations, including displaced persons and refugees. Unfortunately, prior to this time, reproductive health was rarely considered in responses to humanitarian emergencies. Bearing this in mind, the concept of a “Minimal Initial Service Package (MISP)” was created during the Inter-Agency Symposium on Reproductive Health in Emergency Situations held in June 1995. The aim of the MISP is to reduce reproductive health-related mortality and morbidity, particularly among women, during crisis situations. This can be accomplished by providing basic reproductive health services in the early phase of an emergency, including during the establishment of refugee camps. The MISP encompasses a set of activities which must be implemented in a coordinated manner by appropriately trained staff, as well as necessary equipment and supplies. All of the following aspects are important to implementing the MISP: − Appropriately trained personnel, including a coordinator for reproductive health. − Guidelines and training for the implementation of selected interventions. − Essential drugs, basic equipment and supplies necessary to implement the services. The essential drugs, equipment and supplies have been assembled by UNFPA into a set of pre-packaged kits specifically designed for these purposes - The Reproductive Health Kits. The Reproductive Health Kits provide the supplies needed to implement reproductive health in emergency situations in keeping with the objectives of the MISP. The objectives are laid out in the Inter- Agency Field Manual on Reproductive Health in Refugee Situations, namely: „ „ „ „ „ Enforce respect for universal precautions against HIV/AIDS (integrated in all kits) Guarantee the availability of free condoms (Condom kit 1). Prevention and manage of the consequences of sexual violence (Rape Treatment kit 3, Suture of Tears and Vaginal Examination kit 9). Prevent neonatal and maternal morbidity and mortality by providing materials for clean and safe deliveries (Clean Delivery kit 2 and Clinical Delivery kit 6 and Suture of Tears kit 9) . Initiate the establishment of a referral system to manage obstetric emergencies and other pregnancy complications (Treatment of Miscarriage and Management of Complications of Abortion kit 8, Vacuum Extraction for Delivery kit 10, Referral level sub-kit 11 and Blood Transfusion kit 12) 1 History: The first Reproductive Health Kits were developed by Marie Stopes International during the Bosnian crisis in 1992 when thousands of women were sexually abused and there was a need for appropriate medical equipment to assist them. WHO EURO/Sexuality and Family Planning unit reviewed these kits and updated them for a second phase in Bosnia. In 1997, due to unrest, Albania’s health system collapsed and maternity hospitals urgently requested basic surgical equipment to respond to the reproductive health needs of women: the referral/surgical obstetrics kit was designed by the UNFPA Representative to be adapted to local situations. A third version was assembled by IFRC, UNFPA, UNHCR, WHO, etc., to respond to the crisis in the Great Lakes Region in 1997. Taking all these experiences into account, UNFPA decided to consolidate and make available to humanitarian agencies a set reproductive health kits to speed up the implementation of reproductive health services in emergencies. This first version of the reproductive health kit was discussed and agreed upon by the members of the IAWG on Reproductive Health in June 1997 and available from June 1998. The RH Kit was revised and adapted in July 2000 after 2 years of use and more than 60 orders in different crisis situations: a survey among field users was conducted by UNFPA at the end of 1999; the survey results were discussed at the 5th IAWG meeting in February 2000. In July 2000, an IAWG sub-group reviewed all inputs from the field and developed a revised version, with inputs from the IAWG members. After a second evaluation presented at the IAWG in November 2003, additional revisions were made accordingly and the third version of the RH Kits was designed. - 1 - DRAFT „ „ Plan for the provision of comprehensive reproductive health services as soon as the situation allows. Experience has shown that, in addition to providing the MISP, it is also important to respond to the refugees’ needs by initiating complementary Reproductive Health services that include: The provision of contraceptives in order to respond to the demand of women with prior experience with contraceptives (Oral and Injectable Contraception kit 4 and IUD kit 7). ƒ Antibiotics to treat people presenting with symptoms of Sexually Transmitted Infections (STI Treatment kit 5) A Reference and Training Package will be systematically dispatched with each order of any kit. Administration supplies have been included in kit 0 (Administration kit). 1.2. KEY POINTS TO REMEMBER 1.2.1. The Reproductive Health Kits are to be used in the early phase of a crisis situation The Reproductive Health Kits have been created to facilitate the implementation of reproductive health services during the early phase of a crisis 2. Therefore, the Reproductive Health Kits are primarily to be ordered during that phase. The RH Kits contain essential RH drugs, supplies and equipment to be used for a limited period of time and for a fixed number of people. Once the basic reproductive health services have been established, the reproductive health coordinator should analyze the situation, assess the needs and re-order disposables and other equipment necessary to ensure the sustainability of the Reproductive Health program. The re-ordering should be made through the regular channels (NGOs or Agencies’ order forms) or through UNFPA Procurement Unit. 1.2.2. Each kit is formulated to be “self- sufficient” The Reproductive Health Kits have been formulated such that each kit responds to a particular reproductive health need or requirement for a specific number of people for a specific period of time. Thus, each of the kits can be ordered separately as a “stand-alone” response to a particular situation. There is an exception for sterilizing equipment: kits 7, 8 and 9 do not include sterilizing equipment because these kits are usually complimentary to kit 6 (which contains a pressure-cooker type sterilizer). Kit 11 (referral level) does not include an autoclave. 1.2.3. Some kits are designed for use only by qualified and trained health personnel The training required for the use of each kit is detailed in this booklet. You are advised to review this information prior to ordering the kits. 1.2.4. The Reproductive Health Kits are updated on a regular basis The Reproductive Health Kits are updated regularly, based on the most recent available information. Users are invited to comment on the functioning of the sub-kits in the field. All inputs will be considered for future revisions. 2 Primary health care services in emergency situations are implemented through a standardized Emergency Health Kit of essential drugs, supplies and equipment developed 30 years ago by WHO in collaboration with UN Agencies and relief NGO’s. This Kit has been revised in 1998 and is now known as the New Emergency Health Kit 1998 (NEHK– 98). A midwifery kit, emergency contraceptive pills and supplies to respect universal precautions against HIV/AIDS have been added for starting basic components of RH services. To implement more comprehensive RH services in emergency situations, the NEHK - 98 recommends ordering the Reproductive Health Kit. - 2 - DRAFT 1.3. OBTAINING THE KITS 1.3.1. Who can order the kits? UNFPA Humanitarian Response Unit „ „ „ „ „ „ UNFPA Country Offices Funding Agencies such as ECHO, the World Bank, DFID, CIDA, USAID, etc. UN Partner Agencies such as UNHCR, WHO, UNICEF, UNDP, UNAIDS, DPKO, etc. International Agencies such as IFRC, IOM, IPPF, and other NGOs who have entered into a Memorandum of Understanding with UNFPA. Host governments. 1.3.2. Contact points within UNFPA The kits can be ordered directly from: UNFPA Procurement Services Section Midtermolen 3 2100 Copenhagen Denmark Tel: +45 3546 7368 / 7000 Fax: + 45 3546 7018 E-mail: janssens@unfpa.org or dsmith@unfpa.org Information on the Kits or assistance with ordering can be provided by UNFPA Field Offices, Agency partners, or HRU: UNFPA Staff in Field Offices (in the capital city of respective countries) UNHCR or other UN coordinating agency at country level. UNFPA/HRU 220 E 42cd St New York, NY 10012 Tel: +1 212-297-5245 Email: hru@unfpa.org UNFPA/HRU 11-13, chemin des Anémones 1219 Chatelaine, Geneva Switzerland Tel: +41 22 917 83 15 / Fax: +41 22 917 80 16 E-mail: doedens@unfpa.org 1.3.3. Conditions to be fulfilled for ordering the kits A rapid local assessment of the reproductive health situation should be undertaken to confirm need for the kit(s). „ „ „ The type and quantity of Reproductive Health kits being requested should be directly linked to the reproductive health services to be provided and to size of the population to be served. The availability of funds. - 3 - DRAFT Note 1: Kit 11: The pharmaceuticals Diazepam and Pentazocine are controlled substances that require an import license from the country of destination prior to shipment. As in most cases it is not possible to obtain this license in time for prompt shipment, these pharmaceutical products have been removed from the kits 6 and 11. They should be procured locally. Note 2: Oxytocin (kits 6, 8 and 11B) and blood group, HIV, Hepatitis and RPR tests (kit 12) are ‘keep cool’ items requiring the respect of the cold-chain during transportation and storage. These products are now packed separately. Oxytocin must be kept refrigerated whenever possible. Transportation in a cold-chain is recommended for Oxytocin but if the cold-chain is temporarily broken, Oxytocin will remain effective although it can lose some of its efficacy. 1.3.4. Funding (a) With own resources (funding by Governments, NGOs and other Agencies) The Agency places an order directly with UNFPA/HQ Procurement Unit. In this instance, UNFPA requires that funds be received prior to effecting shipment. (b) With UNFPA Funding Funds can be drawn from the regular UNFPA Country Program (including umbrella projects) Field Offices can apply to the Humanitarian Response Unit and Geographic Divisions for emergency funding 1.3.5. Cost of the kits The costs of each kit changes periodically. See attached leaflet for approximate prices and confirm with Procurement Service Section or UNFPA Field Offices for latest prices. . „ „ „ „ „ „ „ „ „ Airfreight costs: an amount calculated at 30% of total cost of each kit should be added to cover these charges (with the exception of the condom kit, for which shipping costs can vary between 30-100%, depending on the destination). Overhead costs: UNFPA charges a nominal fee of 5% to cover associated administrative costs. 1.3.6. Delivery of the order For emergency requirements: 2 to 7 days from the finalization of budget allocation. For non-crisis requirements: 10 to 12 weeks from the finalization of budget allocation. 1.3.7. Information required by the UNFPA Procurement Unit when an order is placed Inform the UNFPA Procurement Services Section of: The availability of funds and the chargeable budget code. Shipment cannot be made unless funding issues are resolved. Name and contact details of the person responsible for ordering and coordinating the delivery of the kits. Name and complete contact details (address, telephone, fax, email) of the consignee responsible for receiving the kits in the field. If multiple country destinations are involved, then a detailed list is required outlining the individual destinations, types and quantities of each kit, contact persons, etc. (e.g. 12 x kit 1 to - 4 - DRAFT hospital A, address, contact person, phone number; 3 x kit 2 to Health Center B, address, contact person, phone number; 2 x kit 11 to Hospital C, etc.). In order to improve the quality of service of these kits, feedback from the recipients is important. We encourage observations on packaging, shipping issues, quality of products, etc. We encourage recipients to revert with suggestions on how the system can be improved. Please address this information to the UNFPA Procurement Services Section. „ „ „ „ „ 1.3.8. Kit packaging To facilitate logistics in-country, UNFPA has organized that the boxes containing the supplies: Are marked with the weight and volume of each kit on the outer carton of the boxes. Are of a size to be handled by one or two people. Are clearly marked on the outside with the kit number, description, consignee and any other relevant information as well as a self adhesive pouch attached to the outside containing a detailed list of contents. Are banded in a particular color on all sides, with one color distinct for each kit (see section 1.4). - 5 - DRAFT 1.4. PRACTICAL INFORMATION The Reproductive Health Kits are divided into three ‘blocks’ as follows: Block 1 Six kits, for use at the community and primary health care level Each will serve the needs of a population of 10,000 persons for 3 months Color code Kit 0 Administration kit Orange Kit 1 Condom kit (Part A and B) Red Kit 2 Clean Delivery kit, individual (Part A and B) Dark Blue Kit 3 Rape Treatment kit (Part A and B) Pink Kit 4 Oral and Injectable Contraception kit White Kit 5 STD Treatment kit Turquoise Block 1 contains 6 kits. Each kit is designed to provide for the needs of 10,000 persons for a 3-month period. The kits contain mainly disposable items. Kits 1, 2 and 3 are divided into parts A and B, which can be ordered separately. Block 2 Five kits for use at primary health care and referral hospital level Each will serve the needs of a population of 30,000 persons for 3 months Color code Kit 6 Clinical Delivery kit Brown Kit 7 IUD kit Black Kit 8 Management of Miscarriage and Complications of Abortion Yellow Kit 9 Suture of Tears (cervical and vaginal) and Vaginal Examination kit Purple Kit 10 Vacuum Extraction Delivery kit Grey Block 2 is composed of 5 kits containing both disposable and reusable material. In order to prevent wastage of expensive reusable equipment, these kits are designed to be used for a population of 30,000 persons over a 3-month period. However, this certainly does not exclude these kits from being ordered for a population of less than 30,000 persons – it simply would mean that the supplies in the kits would last longer. Block 3 Two kits to be used at the referral/surgical obstetric level These will serve the needs of a population of 150,000 persons for 3 months. Color code Kit 11 Referral level kit for Reproductive Health (Part A + B) Fluorescent green Kit 12 Blood Transfusion kit Dark green Block 3 is composed of 2 kits containing both disposable and reusable equipment and supplies for use at the referral/surgical obstetrics level. In most countries the supplies provided in this kit would normally serve a population of approximately 150,000 persons over a 3-month period. In refugee situations, patients are referred to the nearest hospital, which will often require support in terms of equipment and supplies, to be able to provide the necessary services for this additional population. Kit 11 is divided into parts A and B which are usually used together but which can be ordered separately. - 6 - DRAFT 1.4.2 Reference and Training Package A Reference and Training Package will be provided with each kit order. This package includes the following documents and manuals: - Reproductive Health in Refugee Situations: An Inter Agency Field Manual, UNHCR/UNFPA/WHO, 1999 - Reproductive Health During Conflict and Displacement: A Guide for Program Managers. WHO, 2000 - Refugee Reproductive Health Needs Assessment Field Tools, RHR Consortium, 1997 - Sexual and Gender-based Violence against Refugees, Returnees and Internally Displaced Persons: Guidelines on Prevention and Response, UNHCR, 2003 - Guidelines for HIV/AIDS interventions in emergency settings, IASC, 2003 - The Reproductive Health Kit for Emergency Situations, UNFPA/IAWG 2004 - The Reproductive Health Kit (CD-ROM), UNFPA, 2003 - Integrated Management of Pregnancy and Childbirth, Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice. WHO, UNFPA, UNICEF, WB 2003 - Guidelines for the Management of Sexually Transmitted Infections, WHO 2003 The number of Reference and Training packages and language of the manuals included therein are adjusted according to each order and according to the situation. The RHR Manual, for instance, is available in English, French, Spanish, Portuguese, Arabic, and Russian. 1.5. EXAMPLE OF AN ORDER FOR A REFUGEE CAMP OF 20,000 PERSONS Assessment 1. Number of refugees: 20,000 persons 2. Special observations: Female condoms are known and used 3. Level of personnel: 1 medical doctor, 2 trained nurses, 1 trained midwife, birth attendants and health workers. 4. Referral level: Local hospital at 10km, poorly equipped but with trained staff able to perform emergency obstetric procedures Order: Item Quantity Administration kit 0 2 Condom kit 1 (A + B) 2 Clean Delivery kit 2, individual (A+ B) 2 Rape Treatment kit 3 (A +B) 2 Oral and Injectable Contraception kit 4 2 STD Drugs kit 5 2 Clinical Delivery kit 6 ( for Health Facility) 1 IUD kit 7 1 Management of Miscarriage and Complications of Abortion kit 8 1 Suture of Cervical and Vaginal Tears kit 9 1 Vacuum Extraction for Delivery kit 10 1 To support the referral hospital: Referral level kit 11 (A+ B) 1 Transfusion kit 12 1 - 7 - DRAFT Reminder: kits 0-5 support the estimated needs of 10,000 persons for 3 months kits 6-10 support the estimated needs of 30,000 persons for 3 months kits 11 and 12 support the estimated needs of 150,000 persons for 3 months - 8 - DRAFT 2. COMPOSITION OF THE REPRODUCTIVE HEALTH KITS BLOCK 1 KITS SERVING NEEDS OF 10,000 PERSONS FOR 3 MONTHS Kit 0 Administration Kit 1 Condoms, Part A (male condoms) and B (female condoms) Kit 2 Clean Delivery, Part A (for mother) and Part B (for attendants) Kit 3 Rape Treatment, Part A (basic treatment) and B (post-exposure prophylaxis) Kit 4 Oral and Injectable Contraception Kit 5 STI Treatment Block 1 contains 6 kits. Each kit is designed to serve the needs of a population of 10,000 persons for a 3 month period. The kits contain mostly disposable equipment. - 9 - DRAFT KIT 0 ADMINISTRATION/TRAINING SUPPLIES Use: To facilitate administration (and training) activities. Instructions: None. Target population: Community Health Workers and Health Personnel. Contents: Calculator, solar 1 Board, 67 x 100 cm, white adhesive, washable, roll 2 Binder with lever, 310 x 290 mm, various colors 5 Exercise book, 170 x 220 mm, spiral bind, 5mm squared, 180p 20 Exercise book, 210 x 297 mm, spiral bind, 5mm squared, 180p 3 Paper, A4, 210 x 297 mm white, 80g 1,000 Glue, stick, large 3 Sticker UNFPA, 6 x 12 cm 20 Sticker UNFPA, 11 x 22 cm 20 Pencil Ball Point, black 20 Pencil Ball Point, red 20 Marker, black, erasable 12 Marker, red, erasable 12 Marker, blue, erasable 12 Marker, red, large 12 Marker, black, large 12 Pencil, lead HB 20 Pencil sharpener, 2 sizes 2 Scissors, 17 cm, blended 1 Tape, adhesive, 19 x 33 mm, invisible, roll 4 - 10 - DRAFT KIT 1 CONDOMS Use: To provide male and female condoms at all health levels. Instructions: Health and community workers must be trained to explain how to use condoms properly. Target population: Male condoms: Kit contents assume that 20% of the population in a camp is male. (10,000 persons x 20 % = 2,000 males) and 20 % of this group will use condoms (2,000 x 20 % users = 400 users) and that each user will need 12 condoms each month for the three months (400 x 12 x 3 months = 14,400 male condoms). Female condoms: Assuming that around 25% of the population in the camp are potentially sexually active women. (10,000 persons x 25% = 2,500 women) and that 1% will use female condoms (2,500 x 1% users = 25 users) and that each user would need 6 condoms each month (25 x 6 x 3 months = 450 female condoms). Contents: Part A: Male condoms Male Condoms 14,400 20% wastage 2,880 Total 17,280 (120 gross) Safe Sex Leaflets 400 Part B: Female condoms Female Condoms 450 20% wastage 90 Total 540 (3.8 gross) Female Condom use Leaflets 25 Remark: Parts A and B can be ordered separately in different quantities. Depending on the culture of the country where this kit will be used, the pictures in the Safe Sex Leaflets may have to be adapted. - 11 - DRAFT KIT 2 CLEAN DELIVERY KIT (INDIVIDUAL) Use: Individual and clean deliveries at home (or maternity, when under-equipped). Part A: Individual Delivery Packages to be distributed to every woman more than 6 months pregnant. Part B: Equipment for birth attendants According to the situation and local practices, five Birth Attendants can be given a shoulder bag with clean delivery kits and some other items. Instructions: Birth Attendants should be instructed on contents and use of kit 2. Target population: Assumes that with a Crude Birth Rate (CBR) of 4 %, there will be 100 deliveries in 3 months. 100 kits will be used for the women delivering during this period of 3 months, while another 100 kits will be distributed to women who are 6-9 months pregnant. Contents: Part A: Individual delivery: 200 x these items, packed individually Bar of soap 1 Square meter of plastic sheet 1 Razor blade (single edge) 1 String for umbilical cord 3 x 15 cm 1 Pictorial instruction sheet (clean delivery) 1 Sealed bag for packaging 1 Cotton cloth (towel) multicolored 2 m x 1 m 1 or 2 Gloves, examination, latex , medium, disposable, pair 1 Part B: For use by Birth Attendants Shoulder bag (with UNFPA logo) 5 Gloves, examination, latex, medium, disposable - Box of 100 gloves 5 Flash light with batteries “D”1.5V 5 Plastic apron 5 Rain poncho in plastic 5 Remark: Parts A and B can be ordered separately in different quantities. Clothes or material to protect the baby and culturally appropriate sanitary products should be purchased locally wherever possible. Local products are usually less expensive and more familiar to women. - 12 - DRAFT KIT 3 RAPE TREATMENT Use: Management of the immediate consequences of sexual violence with appropriate drugs and supplies. Instructions: Health personnel should be trained to: - conduct pregnancy tests - explain how to use oral emergency contraception, if patient chooses - give clients presumptive treatment for STIs - counsel victims - refer to specialized community and protection services (if appropriate) Target population: Around 25 % of the camp population are potentially sexually active women. (10,000 x 25 % = 2,500). Assume 2 % of these women are raped (2,500 x 2 % = 50 women) and 10 children are raped (5 children weighing less than 30 kg, 5 children weighing 30 kg or more). 50% of clients might need a pregnancy test). Contents: Part A: Basic treatment after a rape, including treatment for children Levonorgestrel 0.75 mg, packet of 2 pills/ per woman 50 pck 10% wastage 5 pck Total 55 pck Azithromycin, 250 mg tablet (4x 250 mg single dose for adults > 45 kg, see treatment protocol for children or adults < 45 kg) Azithromycin 200 mg suspension, 200mg/5ml) 220 5 Cefixime, 200 mg tablet (2x 200 mg single dose for adults > 45 kg) Cefixime, 100mg (suspension, 100mg /5 ml) (See treatment protocol for children) 110 10 Emergency Contraception Leaflet 2 Pregnancy test, temperature stable 25 Clinical Management of Survivors of Rape: a guide to the development of protocols for use in refugee and internally displaced situations, Revised edition, WHO/UNHCR, 2004 1 Remark: • This kit can be used in combination with the Suture of Vaginal and Cervical Tears and Vaginal Examination Kit 9, to manage other consequences of sexual assault. • For tetanus and hepatitis vaccines, refer to the nearest operational health center. Part B: Post Exposure Prophylaxis for HIV, including treatment for children Assuming that 30 adults and 8 children (4 children weighing 10 - 19 kg and 4 children weighing 20 – 39 kg) present within 72 hours of the assault. Post-exposure prophylaxis treatment protocol 1 Zidovuding, 300 mg / Lamivudine, 150 mg tablet combined, (2 x 1/ day x 28 days) 1800 Zidovudine, 100 mg tablet (See treatment protocol for children) 840 Lamivudine, 150 mg tablet, (See treatment protocol for children) 360 - 13 - DRAFT KIT 4 ORAL AND INJECTABLE CONTRACEPTION Use: To respond to women’s needs for hormonal contraception. Instructions: Health personnel should be trained to: - explain advantages and disadvantages of oral and injectable contraception - explain the use of emergency contraception - identify contra-indications for hormonal contraception - give injections Target population: 25 % of the camp population are women between 15 and 49 years (10,000 x 25 % = 2,500). Assuming 15 % of these women use contraception (2,500 x 15% = 375 women): - 30 % use combined oral contraception (375 x 30% = 113 women) - 55% use injectable contraception (375 x 55% = 210 women) - 5 % use Progestin only pills (POP) (375 x 5% = 20 women) - Each month, 5% may need emergency contraception (375 x 5% = 20 women) - (NB: 5% use an intra –uterine device (IUD), see kit 7) Contents: Levonorgestrel 0.15mg + Ethinyloestradiol 0.03mg (113 women x 3 cycles) 340 cycles 10% wastage 34 Total 374 Instruction on use of Combined Oral Contraceptive (Leaflet for Service Provider) 5 Levonorgestrel 0.75 mg, packet of 2 pills/ per woman 60 Emergency Contraception Leaflet (Leaflet for service provider) 2 Progestin-only Pills Levonorgestrel 0.03 mg, 1 cycle ( 20 women x 3 cycles) 60 Instructions on use of POP (Leaflet for service provider) 2 Medroxyprogesterone Acetate Injection 150mg/1ml for 3 months 300 Syringes, disposable, 2ml 300 Needles, disposable, 21G (injection and aspiration) 600 Chlorhexidine sol. 1 liter 3 Cotton wool, absorbent, non sterile, 100g 4 Instruction on use of Injectables (leaflet for Service Provider) 5 Safety box, for used syringes and needles - Capacity 5L 3 Remark: Re-ordering of contraceptives should be made after an initial RH needs assessment and preferably done in bulk through usual channels or UNFPA Procurement Unit. Bulk ordering is less costly. - 14 - DRAFT KIT 5 TREATMENT OF SEXUALLY TRANSMITTED INFECTIONS (STI) Use: - To diagnose and treat STIs in people presenting with complaints Instructions : Health personnel should be trained to: diagnose and treat STIs according to syndromic approach explain the importance of treating the partner promote and explain the use of condoms Target population: Assuming: 50% of the camp population are adults (50% of 10,000= 5,000) - 5% of the adults have STDs (5% x 5,000 = 250 persons) - 20% have genital ulcer syndrome (20% x 250 persons = 50) - 50% have urethral discharge syndrome (50% x 250 persons = 125) - 30% have vaginal discharge syndrome (30% x 250 persons = 75) - For each syndrome 25 additional patients are children (10 children < 30 kg, 15 children 30 – 45 kg) Contents: Genital ulcer syndrome Benzathine Benzyl-penicillin 2.4 units, 1 dose 65 Benzathine Benzyl-penicillin 1.2 units, 1 dose 10 Syringes, disposable, 5ml 75 Needles, disposable, 21G 150 Water for injection 10ml 75 Cotton wool, absorbent, not sterile, 100g 3 Chlorhexidine sol. 5%, 1 liter 3 *Azithromycin 250 mg tablet 240 *Azithromycin 200 mg suspension, 200mg/5ml 10 Urethral discharge syndrome **Cefixime, 200 mg tablet 270 **Cefixime, 100mg, suspension, 100mg /5 ml 20 *Azithromycin 250 mg tablet 540 *Azithromycin 200 mg suspension, 200mg/5ml 10 Vaginal discharge syndrome (treat for vaginitis and cervicitis) Metronidazole 250mg tablets (2 g single dose or 500mg 2/day x 7 days) 2,000 Clotrimazole 500 mg pessaries (single dose) 100 **Cefixime, 200 mg tablet 200 **Cefixime, 100mg, suspension, 100mg /5 ml 10 *Azithromycin 250 mg tablet 340 *Azithromycin 200 mg suspension, 200mg/5ml 10 Condom distribution Condoms (20 gross) 3,000 Female condoms (3 per woman) 90 Safe Sex Leaflets 100 Female Condom use leaflets 30 WHO STI guidelines/poster 1 Safety box, for used syringes and needles - Capacity 5L 4 Envelope, plastic, 10 x 15cm - pack of 100 (for drugs/tabs distribution) 10 *Azithromycin: Single dose: 4 x 250 mg for adults > 45 kg. See treatment protocol for <45 kg or children - 15 - DRAFT **Cefixime: Single dose 2 x200 mg for adults > 45 kg. See treatment protocol for < 45 kg or children Remark: Re-ordering of drugs should be done after a needs assessment and should be based on the national STI treatment protocol. The antibiotics in the national protocol may be different from those in this kit. HIV testing is not included. Testing should be provided through a VCT program, and not in isolation. - 16 - DRAFT BLOCK 2 FIVE KITS FOR 30,000 PERSONS / 3 MONTHS Kit 6 Clinical Delivery Assistance Kit 7 Intra Uterine Device Kit 8 Management of Miscarriage and Complications of Abortion Kit 9 Suture of Tears (cervical and vaginal) and Vaginal Examination Kit 10 Vacuum Extraction Delivery Assistance Block 2 is composed of 5 kits containing disposable and reusable material. In order to prevent wastage of this reusable and expensive equipment, these kits are designed to be used for a population of 30,000 persons for 3 months. However, this certainly does not exclude the use of these kits in a setting of less than 30,000 persons. In such a case, the supplies will last for a longer period than three months. - 17 - DRAFT KIT 6 CLINICAL DELIVERY ASSISTANCE Use: In health facilities: - to perform normal deliveries - to suture episiotomies and perineum tears under local anesthesia - to stabilize patients with serious complications before sending to referral level (e.g. eclampsia, hemorrhage: to place a drip, give specific drugs) Instructions: For use by trained personnel: midwives, nurses with midwifery skills and medical doctors. Target population: In a population of 30,000 persons with a CBR of 4%, 300 deliveries would occur in 3 months. Assuming 15% will deliver in the health facility (300 x 15%) there must be equipment for 45 deliveries. The estimated number of pregnant women in the population would include 300 in their first trimester, 300 in the second trimester and 300 in the last trimester).? Contents: General equipment Sphygmomanometer,(adult),aneroid 1 Stethoscope, binaural, complete 1 Stethoscope, foetal, monaural 2 Basin Kidney, 825ml Stainless steel 2 Thermometer, clinical, digital 32-43C 4 Surgeon’s Hand Brush, white nylon Bristles 2 Apron, protection, plastic, reusable 2 Drawsheet, plastic, approx. 90x180cm 2 Tourniquet, latex rubber, approx. 75cm 2 Drugs Amoxicillin 250mg tablets 5,000 Metronidazole 250mg tablets 2,100 Tetracycline eye ointment, 1 tube 6 Xylocaine, 20 ml vial 20 Oxytocin, 10 IU/ml (packed and sent separately in cold-chain)* 50 Saline Solution 0,9%, 1 liter + IV- infusion set 15 Dextrose 5%, 1 liter + IV infusion set 20 Plasma-expander, 500ml +IV set 20 Magnesium Sulfate, Injectable, 10 ml 10 Guidelines for Management of women with pre-eclampsia and eclampsia 1 Calcium Gluconate, amp10 ml, 100 mg/ml, 5 Water for injection, 10ml 20 Chlorhexidine 5%, 1 liter 12 Urinary Protein Test Strips - Box of 50 3 Ferrous sulfate 200 mg and Folic acid 25 mg - Box of 1000 (cure of 1 month) 5 - 18 - DRAFT Disposable equipment Soap,toilet,bar,approx.110g,wrapped 30 Gloves, Surgical, latex, size 8, sterile, disposable, PAIR 30 Gloves, Surgical, latex, size 7, sterile, disposable, PAIR 30 Gloves, long for manual removal of placenta, medium size, disposable, PAIR 5 Gloves, examination, latex, medium, disposable - Box of 100 gloves 3 Tape,umbilical, 3mmx50m, non-sterile 1 Catheter,urethral,CH12,ster,disposable 20 Extractor, mucus, 20 ml, sterile, disposable 50 Tube, suction, CH10, L50cm, conical tip, sterile, disposable 10 Tube, suction, CH12, L50cm, conical tip, sterile, disposable 10 Syringe,feeding,conical tip,50ml,ster,disp 10 Suture, synth, absorb, DEC3 (2/0) needle semi-circled 3/8, round 36 Gauze-pad, sterile 12-PLY 10 x 10 cm - Pack of 5 gauze-pads 50 Cannula, IV short,20G,ster,disp 25 Tape, adhesive tape, roll, 2 cm x 5m 5 Syringes, disposable, 10ml 50 Syringes, disposable, 2ml 100 Needles, disposable, 21G 200 Cotton wool, 500g, roll, non-ster 5 Safety boxes for used Syringes and needles – Capacity 5L 6 Envelope, plastic, 10 x 15cm - pack of 100 (for drugs/tabs distribution) 10 Plastic goggles 2 Delivery set Scissors,Mayo,140mm,cvd,b/b (cord cutting) 1 Scissors,gyneco,200mm,cvd,b/b (episiotomy) 1 Forceps,artery,Kocher,140mm,str 2 Instrument Box, stainless steel, 18 x 8 x 4 cm 1 Suture set Scissors dissect Straight Mayo 170mm B/B SS 1 Holder Needle straight Mayo HGR 160mm 1 Tissue Forceps, spring-type 1 x 2 teeth, 150mm 1 Instrument Box, stainless steel, 20 x 10 x 3 cm 1 Administration Exercise Book A5 ruled 8mm, 48 pages 2 Pen, Ball-point Blue 10 Multi-purpose vinyl bag for kit 1 Sterilizing equipment Stove, kerosene single burner pressure type 2 Sterilizer dressing, press 350 x 380 mm/39l fuel 1 Indicator, TST control spot – pack of 300 1 Timer, 60 min 1 Instructions for sterilizing by pressure cooker and autoclave (MSF) 1 Lighting Frontal lamp, with adapter for 4 batteries R6 1 Battery, dry cell, R6, Alkaline, 1.5V, (14 x 50mm) 10 Kerosene Storm-lamp + extra socks 1 - 19 - DRAFT Remark: Partographs can be obtained by making copies of the model in the Inter-Agency Field Manual for Reproductive Health in Refugee Situations. 10 vials of injectable Diazepam 5 mg/ml, 2 ml, are not included because of import licensing requirements. This drug should be purchased locally. NOTE : */ These items require respect of the cold chain during transport and storage and are therefore packed and sent separately. - 20 - DRAFT KIT 7 INTRA UTERINE DEVICES (IUD) Use: - To insert IUDs as contraception - To remove IUDs - To provide preventive antibiotic treatment Instructions: Health personnel to be trained to insert IUDs. Target population: Assumes 25% of the female population is between 15 and 45 years (30,000 x 25% = 7,500) and 15% of these women are contracepting (7,500 x 15% = 1,125). Assumes 5% of contracepting women will choose an IUD (1,125 x 5% = 60 women). Contents: Set for insertion and removal of IUD Speculum, vaginal, bivalve, Graves, small SS 1 Speculum, vaginal, bivalve, Graves, medium SS 2 Speculum, vaginal, bivalve, Graves, large SS 1 Forceps sponge-holding straight 200mm 1 Forceps, artery, Pean/Roch,220mm,str 2 Sound, uterine, Martin, 320mm 3 Forceps,uterine,Duplay,280mm,cvd 1 Scissors, gyneco, 200mm, cvd, b/b 1 Tray, instruments, stainless steel, appr. 320x200x80mm,w/cover 1 Intra-Uterine Device (IUD), Cu-T 380 A 90 Doxycycline 100mg tablets (2 tablets single dose) 200 Envelope, plastic, 10 x 15cm - pack of 100 (for drugs/tabs distribution) 1 Gloves, surgical, latex, size 8, sterile, disposable, PAIR 50 Gloves, surgical, latex, size 7, sterile, disposable, PAIR 50 Chlorhexidine sol. 5% 1l 3 Compress, gauze, 10x10cm, sterile,vdisp - Pack of 5 200 Bowl,stainless steel,approx.180ml 1 Basin, kidney, stainless steel,approx.825ml 2 Remark: Kit 7 does not include sterilizing equipment. Kit 7 is usually ordered in complement to the Delivery Kit 6 which includes a pressure sterilizer. If Kit 7 is ordered without Kit 6, then sterilizing equipment should be purchased separately. - 21 - DRAFT KIT 8 MANAGEMENT OF MISCARRIAGE AND COMPLICATIONS OF ABORTION Use: To treat the complications arising from miscarriage (spontaneous abortion) and from unsafe induced abortion, including sepsis, incomplete evacuation and bleeding. Instructions: Equipment must be used by health personnel who are trained to treat miscarriages and to manage the complications of abortion, including performing uterine evacuations. Target population: Assuming 20% of pregnancies may result in miscarriage (spontaneous abortion) or that there may be equivalent number of complications of unsafe abortion, there may be need for treatment of 60 women in a three month period. Contents: Manual Vacuum Aspiration (MVA) Set (IPAS set - 2 x IA18) Double valve syringes 4 Replacement double valve set 2 Canula Flexible 6mm sterile disposable 8 Canula Flexible 7mm sterile disposable 8 Canula Flexible 8mm sterile disposable 8 Canula Flexible 9mm sterile disposable 4 Canula Flexible 10mm sterile disposable 4 Canula Flexible 12mm sterile disposable 4 Set of adapters 2 15ml bottles of silicone 8 Denniston dilatators, set of 5, IPAS5 double-ended, tapered dilators (covering a range of 3mm-14mm) 4 Leaflet on treatment of incomplete abortion, (IPAS) 1 French + 1 English Manual vacuum aspiration Guide for Clinicians, (IPAS) 1 French + 1 English Manual Vacuum Aspiration. Extract from Managing Complications in Pregnancy and Childbirth, WHO, 2000 1 French + 1English Protocol for Reusing MVA IPAS Instruments 1 French + 1 English Set D&C (MSF-based KSURBCUR18-) Curette Gordet, 12 cm, blunt, MED 7812 1 Curette Simon, 6 mm, blunt, MED 7807 1 Curette Cuzzi, 17 mm, blunt, MED 7813 1 Dilator, Hegar, simple, 4 mm, MED 7071 1 Dilator, Hegar, simple, 6 mm, MED 7071 1 Dilator, Hegar, simple, 8 mm, MED 7071 1 Dilator, Hegar, simple, 10 mm, MED 7071 1 Dilator, Hegar, simple, 12 mm, MED 7071 1 Dilator, Hegar, simple, 14 mm, MED 7071 1 Dilator, Hegar, simple, 16 mm, MED 7071 1 Dilator, Hegar, simple, 18 mm, MED 7071 1 Forceps, Cheron dressing, 25 cm, straight, MED 7317 1 - 22 - DRAFT Forceps, Muzeux, 24 cm, jaw 10 mm, MED 7459 1 Gallipot, 8 cm, stainless steel, 100ml 1 Probe, uterine, Sims, MED 7105 1 Retractor, Doyen, 85 x 45 mm, straight, MED 7065 1 Speculum Collin, 35 mm, 100 mm MED 7034 1 Speculum, Jayle, with detachable weight 1 Box instrument, stainless steel, 40 x 20 x 10 cm 2 Disposable Gloves, surgical, latex size 8, sterile, disposable, PAIR 50 Gloves, surgical, latex size 7, sterile, disposable, PAIR 50 Gloves, examination, latex, medium, disposable - Box of 100 gloves 1 Syringe, luer, 10ml, sterile, disposable 200 Syringes, disposable, 10ml 100 Syringes, disposable, 2ml 100 Needles, disposable 21G 200 Gauze-pad, sterile 12-PLY, 76 x 76 mm – Pack of 20 60 Envelope, plastic, 10 x 15cm - pack of 100 (for drugs/tabs distribution) 1 Safety boxes for used Syringes and needles – Capacity 5L 3 Drugs Doxycycline 100mg tablets 1,000 Metronidazole 250mg 2,000 NaDCC tabs – box of 200 (to replace bleach solution) 2 Ibuprofen 400 mg tablets, 2 tabs per woman (1 prior to discharge and 1 to take home) 120 Oxytocin 10 IU injection, 1ml packed and sent separately in cold-chain * 100 Lidocaine 1%, vial 20ml 50 Atropine sulfate 500mcg BP injection 1ml 30 Water for injection, vial 10ml 10 Chlorhexidine Solution (Hibiscrub) 500ml 3 Chlorhexidine solution 5% 1l 10 Medical Stationary Leaflet for women 60 Remarks: ƒ Health coordinators should make all possible efforts to encourage (manual) vacuum aspiration rather than sharp curettage. ƒ Kit 8 does not include sterilizing equipment. Kit 8 is usually ordered in complement to the Clinical Delivery kit 6, which includes a pressure sterilizer. If kit 6 has not been ordered, then sterilizing equipment should be purchased separately through usual channels or UNFPA Procurement unit. ƒ (Important: Plastic MVA Instruments should not be autoclaved but rather sterilized (High Level Disinfected) by boiling (20 minutes) or with bleach solution (see reutilization protocol). NOTE : */ These items require respect of the cold chain during transport and storage and are therefore packed and sent separately. - 23 - DRAFT KIT 9 SUTURE OF TEARS (VAGINAL AND CERVICAL) AND VAGINAL EXAMINATION Use: - To suture cervical and vaginal tears - To examine women who are victims of sexual assault Instructions: To be used by trained health personnel: midwives, physicians or nurses with midwifery skills. Target population: Assumes that 15% of delivered women will need suturing (besides episiotomy). 15% x 300 deliveries: 45 women during 3 months. Contents: Set cervix and vaginal tears suture Scissors, Mayo, 170mm, curved, b/b 1 Needle holder, Mayo-Hegar,180mm,straight 1 Retractor vaginal Doyen medium blade 2 Speculum, vaginal, Graves, 75x20mm 1 Speculum, vaginal, Graves, 95x35mm 1 Speculum, vaginal, Graves, 115x35mm 1 Forceps sponge-holding straight 200mm 2 Tray, instruments, stainless steel, appr. 320x200x80mm,w/cover 1 Suture, synthetic, absorb, DEC4 (1), needle 1/2, 36 mm, tri – Box of 12 6 Suture, synthetic, absorb, DEC3 (2/0), needle semi-circled 3/8, 30 mm, round – Box of 12 5 Suture Chromic absorbable 0/0, needle semi –circled - Box of 12 6 Compress, gauze, 10x10cm, sterile,disp – Pack of 5 80 Gloves, surgical, size 8, sterile, disposable, PAIR 40 Gloves, surgical, size 7, sterile, disposable, PAIR 40 Gloves, examination, size medium, disposable - Box of 100 gloves 2 Vaginal lubricant jelly/exploration gel 1 Chlorhexidine 5% sol. 1 liter 4 Povidone iodine sol 10% BOT/500ml 2 Remark: In case of sexual assault, use this kit in combination with Rape Treatment kit 3 if emergency contraception or antibiotic treatment are required. „ „ Kit 9 does not include sterilizing equipment. Kit 9 is usually ordered in complement to the Clinical Delivery kit 6 which includes a pressure sterilizer. If this is not the case, sterilizing equipment should be purchased separately through the usual channels or through UNFPA procurement. - 24 - DRAFT KIT 10 VACUUM EXTRACTION DELIVERY Use: To perform manual vacuum extraction. Instructions: To be used by trained health personnel: physicians, midwives or nurses with midwifery skills. Target population: Deliveries which require vacuum extraction assistance. Contents: Vacuum extractor, Bird, manual, complete set 1 Spare bottle 1 - 25 - DRAFT BLOCK 3 KITS TO BE USED AT THE REFERRAL/SURGICAL MATERNITY LEVEL FOR 150,000 PERSONS / 3 MONTHS Kit 11 Reproductive Health Referral level supplies (Part A+B) Kit 12 Transfusion kit Block 3 is composed of 2 kits containing disposable and reusable materials for use at the referral (surgical obstetrics) level. The equipment and supplies are designed to serve a population of approximately 150,000 persons for three months. In refugee situations, referrals are generally sent to local hospitals which may need to be supported with additional equipment and supplies in order to be able to take care of this extra caseload. Kit 11 is composed of Parts A and B, which are usually used together but can be ordered separately. - 26 - DRAFT KIT 11 REFERRAL LEVEL KIT FOR REPRODUCTIVE HEALTH PART A: REUSABLE EQUIPMENT This kit is used together with Kit 11 Part B. Use: - To perform cesarean sections and other obstetric surgical interventions - To resuscitate mothers and babies - To start IV antibiotic treatment for puerperal sepsis and pelvic inflammatory disease Instructions: To be used by medical staff who are able to perform obstetric surgery and manage complications of pregnancy and delivery and STIs. Contents: Box, abdominal, 42 instruments (MSF: KSURBABD42-) Box, instrument, stainless steel, 40 x 20 x 10 cm 1 Clamp, towel, Backhaus, 10,5 cm 4 Forceps, artery, Bengolea, 20 cm, curved cross serr. 2 Forceps, artery & tissue, Chaput, 14 cm, 2 x 3 teeth 2 Forceps, artery, Crafoord (Coller), 24cm, curved 2 Forceps, artery Kelly, 14cm, curved 10 Forceps, artery, Halsted-Mosquito, 12,5cm, curved 6 Forceps, artery Kocher, 14cm, straight, 1 x 2 teeth 2 Forceps, artery, Mixter, 23cm, delicate 2 Forceps, dressing, standard, 14,5 cm, straight 1 Forceps, dressing, standard, 25 cm, straight 1 Forceps, intestinal, Doyen, 23 cm, curved 2 Forceps, peritoneal, Faure, 21 cm, slightly curved 2 Forceps, tissue grasping, Duval, 23 cm , jaws 20mm 2 Forceps, tissue, standard 14,5cm, 1 x 2 teeth, straight 1 Forceps, tissue, standard 25 cm, 1 x 2 teeth, straight 1 Gallipot, 500ml, 12cm, stainless steel 1 Needle holder, Mayo-Hegar, 18cm, standard pattern 1 Retractor, abdominal Collin, 110mm bla., 80 x 38 65 x 55mm 1 Retractor, abdominal Gosset, 2 blades 55mm, op.115mm 1 Retractor, abdominal Rochard Fixation unit 19cm foldable 1 Retractor, abdominal Rochard, 115 x 65 mm, 28 cm 1 Retractor Farabeuf, double ended, 15 cm, pair 1 Scalpel handle, n°4, standard 1 Scissors, Metzembaum, curved, 18 cm 1 Scissors, Nelson (Mezembaum), curved, 23 cm 1 Scissors, Mayo, 17 cm, curved 1 Scissors, Mayo, 23 cm, curved 1 - 27 - DRAFT Spatula, Ribbon retractor, malleable, 27 x 25 cm 2 Tube suction,Yankauer,270mm 1 Below this is not MSF abdominal kit, move to 11B or delete Suction tube, 22,5 cm, 23 French Gauge 2 Round-bodied needles n°12, size 6 (packed of 12) 4 Triangular point suture needles, 7,3 cm, size 6 (packed of 20) 2 Glasses, safety, regular size, disposable 2 Embryotomy set Cranioclast, Braun, 42 cm 1 Hook, decapitation, Braun, 31 cm 1 Perforator, Smellie, straight, 27 cm 1 Scissors, gyneco, curved, blunt/blunt, 27 cm 1 Disinfecting equipment Bowl, stainless steel, approx. 180ml 1 Forceps, dressing, Cheron, 25 cm 1 Suction apparatus Pump, suction, foot-operated 1or 2? Suction apparatus foot operated for adults 1 Suction apparatus pediatric foot-operated 1 Resuscitation equipment Resuscitator, hand-operated, infant/child, set 2? Resuscitator, hand-operated, adult, set 1 Airway, Guedel, translucent, size 00, 0, 1, 2, 3,4 1 of each Managing Complications in Pregnancy and childbirth: A guide for midwives and doctors. WHO-UNFPA-UNICEF-WB, 2003 1 Remark: This kit does not include an autoclave for sterilizing instruments or materials. If not available, this can be directly ordered through the regular channels or through UNFPA. „ „ No surgical drapes are included. If not available, they should be purchased locally. - 28 - DRAFT KIT 11 REFERRAL LEVEL KIT FOR REPRODUCTIVE HEALTH PART B: DRUGS AND DISPOSABLE EQUIPMENT This kit is to be used together with kit 11 Part A. Use: - To perform cesarean sections and other obstetrical surgical interventions - To resuscitate mothers and newborns - To start IV antibiotic treatment for puerperal sepsis and pelvic imflammatory disease Instructions: To be used by medical staff who are able to perform obstetric surgery and who are trained to manage complications of pregnancy and delivery and STIs Target population: In a population of 150,000 with a CBR of 4 %, there will be 6,000 deliveries during 12 months, or 1,500 deliveries during 3 months. Approximately 5% of these will require cesarean section (5% x 1,500 = 75). Approximately 30 additional women will need other emergency care. Contents: Drugs Ampicillin Powder, 1g, vial 400 Gentamycin, injectable, 2ml, 40mg/ml 1,050 Water for injection, 20ml 400 Metronidazole, injectable, 100ml, plastic pouch, 5mg/ml – Box of 50 4 Methylergometrine, injectable, 1ml, 0,2mg/ml 200 Oxytocin, injectable, 1ml, 10IU (packed and sent separately in cold-chain)* 200 Xylocaine 1%, vial, 20ml 120 Calcium Gluconate, injectable, 10ml, 100mg/ml 30 Magnesium sulfate, injectable, 10ml 100 Guidelines for Management of women with pre-eclampsia and eclampsia 1 Hydralazine, injectable, 12,5mg/ml, 2ml 60 Quinine di-chlorhydrate, injectable, 2ml, 300mg/ml 200 Metronidazole 250mg, tab 1,000 Amoxicillin 500mg, tab 2,000 Paracetamol 500mg, tab 2,000 Quinine sulfate 300mg, tab 1,000 Doxycycline 100mg, tab 1,400 Pregnancy test, temperature stable 20 Tetracycline eye ointment 30 Dextrose 5% + infusion giving set 300 Saline Solution 0,9% + infusion giving set 300 Haemacell 500ml + infusion giving set 100 Chlorhexidine soap 500ml (Hibiscrub) 100 NaDCC tabs – box of 200 2 Chlorhexidine sol. 5% 1 liter 30 Lidocaine 2%, vial, 20 ml 100 - 29 - DRAFT Lidocaine heavy, 5% 100 Ketamine injectable, 10ml, 50mg/ml 50 Water for injection, 20ml 100 Renewable supplies Tube, suction, CH10, L50cm, conical tip, sterile, disposable 60 Tube, suction, CH12, L50cm, conical tip, sterile, disposable 60 Cannula, IV short, 20G, sterile, disposable 500 Cannula, IV short, 18G, sterile, disposable 100 Needle, luer, 23G(0.6x25mm),sterile, disposable 100 Syringe, luer, 1ml, sterile, disposable 50 Tape,adhesive,zinc oxide,2.5cmx5m 50 Infusion giving set 200 Brush, hand, scrubbing, plastic 10 Gloves, surgical, size 8, sterile, disposable, PAIR 400 Gloves, surgical, size 7, sterile, disposable, PAIR 400 Gloves, gynaecological, size 7.5,sterile, disposable, pair 10 Gloves, examination, size medium, disposable - Box of 100 gloves 5 Suture, Synthetic, absorbable, DEC4 (1), needle 36 mm, 4/8, tri 280 Suture, Synthetic, absorbable, DEC3 (2/0) needle 4/8, 30mm, round 140 Suture, Synthetic, absorbable, DEC3 (2/0), spool 140 Suture, Synthetic, non-absorbable DEC3 (2/0), needle 3/8, 30mm, tri 140 Catheter, Foley, CH14, sterile, disposable 150 Bag, urine, collecting, 2000ml 150 Towel, surgical, 50% polyester-50% cotton, 100 x 150 cm 6 Needle, spinal, 22G (0.7x90mm), sterile, disposable 120 Syringe, luer, 2ml,sterile,disposable 500 Syringe, luer, 5ml,sterile, disposable 200 Syringe, luer,10ml, sterile, disposable 500 Needle, luer, 21G(0.8x40mm), sterile, disposable 1200 Compress, gauze, 10x10cm, sterile, disposable – Pack of 5 200 Tape, adhesive, zinc oxide, perforated, 10cmx5m 5 Surgical knife blades n°10 100 Safety box, for used syringes and needles - Capacity 5L 5 Bag (envelope), plastic, for drugs, approx.10x15cm - pack of 100 10 Remark: (Diazepam, injectable, 2ml, 5mg/ml (50 amp) and Pentazocine, injectable, 30 mg/3ml, 1ml (6 amp) not included because of import/export licensing requirements and should be purchased locally. Culturally appropriate sanitary products should be purchased locally wherever possible. NOTE : */ These items require respect of the cold chain during transport and storage and are therefore packed and sent separately. - 30 - DRAFT KIT 12 BLOOD TRANSFUSION Use: To perform safe blood transfusions after testing for HIV, syphilis and hepatitis B and C. Instructions: The existence of a basic laboratory and a trained laboratory technician are required for the use of this kit. Target population: Persons requiring blood transfusions. Contents: (Adapted from MSF) Blood-group Test, anti A, 10ml, fl.dropper* 1 Blood-group Test, anti A + B, 10ml, fl.dropper* 1 Blood-group Test, anti B, 10ml, fl.dropper* 1 Rhesus Test, anti D, 10ml, dropper* 1 HIV Test 1 + 2, 100 tests, kit* 1 HBsAg rapid test, 100 tests 1 HCV rapid test, 100 tests* 1 RPR test, 100 tests* 1 Microcentrifuge, hematocrit (Battery/mainstream) “Compur” + Transformer 1 Capillary Tube for hematocrit per microcentiliter “Compur” (9 microliter) 200 Cuff for pression, for bag 500/1,000ml 1 Battery, R14, C, alkaline, 1.5V, 26 x 50 mm 6 Blood-bag + CPD, (citrate de sodium, phosphorus hydrogen, dextrose), 250ml 50 Blood IV-set 100 Gloves, examination, latex, size medium, disposable - Box of 100 gloves 5 Remark: NOTE : */ These items require respect of the cold chain during transport and storage and are therefore packed and sent separately. - 31 - DRAFT ANNEX ASSUMPTIONS USED FOR CALCULATING SUPPLIES NEEDED IN UNFPA REPRODUCTIVE HEALTH KITS FOR EMERGENCY SITUATIONS Summary Table 3 months of use Basic Data on Population Kits 1 to 5 10,000 persons Kits 6 to 10 30,000 persons Kits 11 & 12 150,000 persons 20% are male 2,000 „ 25% are women aged between 15-49 yrs Women in Reproductive Age (WRA) 2,500 „ Crude Birth Rate (CBR) at 4%. No. of deliveries in 12 months No of deliveries in 3 months No of pregnant women 400 100 300 1,200 300 900 6,000 1,500 „ „ „ „ 2% of WRA experience sexual violence 50 „ 15% of WRA use contraception of which 40% use oral contraceptives of which 55% use injectables of which 5% use IUDs 375 150 206 19 60 „ 20% of pregnancies end in miscarriage or unsafe abortion 60 „ 15% vaginal tears/300 deliveries 50 „ 5% caesarian section on 1,500 deliveries 75 „ - 32 - DRAFT COST OF SELF CONTAINED UNFPA REPRODUCTIVE HEALTH KITS Block 1 Kit 0: Administration 140 Kit 1: Condom Part A US$ 438 Part B US$ 400 Kit 2 Clean delivery (individual) Part A US$ 290 Part B US$ 100 Kit 3 Treatment of Sexual Violence Part A US$ 130 Part B US$ 750 Kit 4 Oral and injectable contraception US$ 450 Kit 5 STD US$ 255 Block 2 Kit 6 Clinical Delivery (Health Facility) US$ 715 Kit 7 IUD US$ 155 Kit 8 Management of miscarriage/complications of abortion US$ 545 Kit 9 Suture of cervical and vaginal tears US$ 260 Kit 10 Vacuum extraction for delivery (manual) US$ 90 Block 3 Kit 11: Referral level Part A US$ 470 Part B US$ 2,905 Kit 12: Transfusion US$ 800 Remark: - Current (updated) prices can be obtained from UNFPA Procurement Unit. - 30% should be added for shipping costs for all kits except for the condom kit 1. Shipping costs for condoms can vary between 30% - 100% depending on the destination. - UNFPA charges 5% handling fee on top of these prices to contribute to overhead costs. - 33 - DRAFT Destination: Project No. Requester: REG No. Date: Name Kit No. Quantity Unit Price Total Administration kit Kit No.0 Male Condoms kit Kit No. 1A Female Condoms kit Kit No. 1B Clean Delivery, Individual Kit No. 2A Clean Delivery, For use by Birth Attendants Kit No. 2B Rape Treatment kit- basic treatment Kit No. 3A Rape Treatment kit- post-exposure prophylaxis Kit No. 3B Oral and Injectable contraception kit Kit No. 4 Sexually Transmitted Infections (STI) kit Kit No. 5 Clinical Delivery kit Kit No. 6 Intra Uterine Devices (IUD) kit Kit No. 7 Management of Complications of Miscarriage Kit No. 8 Suture of Tears (cervical and vaginal) and Vaginal Examination kit Kit No. 9 Vacuum Extraction Delivery kit Kit No. 10 Referral Level, Reusable Equipment kit Kit No. 11A Referral Level, Drugs and Disposable Equipment Kit No. 11B Blood Transfusion kit Kit No. 12 Total of goods Freight charges Handling charges (5%) GRAND TOTAL Tel: Fax: SHIPPING MARKS: MODE OF TRANSPORT: Fax: NOTIFY PARTY IF DIFFERENT FROM ABOVE: Name: Country: E-mail: Tel: E-mail: Attn: RH kits Order Sheet PO Box: Street Address: CONSIGNEE DETAILS: - 34 - acknowledgement  Enforce respect for universal precautions against HIV/AIDS (integrated in all kits)  Guarantee the availability of free condoms (Condom kit 1).  Prevention and manage of the consequences of sexual violence (Rape Treatment kit 3, Suture of Tears and Vaginal Examination kit 9).  Prevent neonatal and maternal morbidity and mortality by providing materials for clean and safe deliveries (Clean Delivery kit 2 and Clinical Delivery kit 6 and Suture of Tears kit 9) .  Plan for the provision of comprehensive reproductive health services as soon as the situation allows.  The provision of contraceptives in order to respond to the demand of women with prior experience with contraceptives (Oral and Injectable Contraception kit 4 and IUD kit 7). kit 1 condoms Part A: Male condoms kit 2 clean delivery kit (individual) kit 5 treatment of sexually transmitted infections (sti) Safety boxes for used Syringes and needles – Capacity 5L Kerosene Storm-lamp + extra socks Denniston dilatators, set of 5, IPAS5 double-ended, tapered dilators (covering a range of 3mm-14mm) Dilator, Hegar, simple, 4 mm, MED 7071 kit 10 vacuum extraction delivery kit 11 referral level kit for reproductive health kit 11 referral level kit for reproductive health part b: drugs and disposable equipment kit 12 blood transfusion ANNEX Cost of Self Contained UNFPA Reproductive Health Kits

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